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Menichelli C, Casamassima F, Aristei C, Ingrosso G, Borghesi S, Arcidiacono F, Lancellotta V, Franzese C, Arcangeli S. Stereotactic radiotherapy for liver oligometastases. Rep Pract Oncol Radiother 2022; 27:32-39. [PMID: 35402041 PMCID: PMC8989451 DOI: 10.5603/rpor.a2021.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/14/2021] [Indexed: 11/25/2022] Open
Abstract
The liver is the first metastatic site in 15–25% of colorectal cancer patients and one of the first metastatic sites for lung and breast cancer patients. A computed tomography (CT ) scan with contrast medium is a standard procedure for assessing liver lesions but magnetic resonance imaging (MRI) characterizes small lesions better thanks to its high soft-tissue contrast. Positron emission tomography with computed tomography (PET-CT ) plays a complementary role in the diagnosis of liver metastases. Triphasic (arterial, venous and time-delayed) acquisition of contrast-medium CT images is the first step in treatment planning. Since the liver exhibits a relatively wide mobility due to respiratory movements and bowel filling, appropriate techniques are needed for target identification and motion management. Contouring requires precise recognition of target lesion edges. Information from contrast MRI and/or PET-CT is crucial as they best visualize metastatic disease in the parenchyma. Even though different fractionation schedules were reported, doses and fractionation schedules for liver stereotactic radiotherapy (SRT ) have not yet been established. The best local control rates were obtained with BED10 values over 100 Gy. Local control rates from most retrospective studies, which were limited by short follow-ups and included different primary tumors with intrinsic heterogeneity, ranged from 60% to 90% at 1 and 2 years. The most common SRT-related toxicities are increases in liver enzymes, hyperbilirubinemia and hypoalbuminemia. Overall, late toxicity is mild even in long-term follow-ups.
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Affiliation(s)
| | | | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | | | - Valentina Lancellotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy
| | - Ciro Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Milan, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan Bicocca, Milan, Italy
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Impact of Progressive Site-Directed Therapy in Oligometastatic Castration-Resistant Prostate Cancer on Subsequent Treatment Response. Cancers (Basel) 2022; 14:cancers14030567. [PMID: 35158833 PMCID: PMC8833545 DOI: 10.3390/cancers14030567] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Local treatment for oligometastatic hormone-naive prostate cancer has been shown to be effective in phase II trials. As for the efficacy of targeted therapy for oligometastatic castration-resistant prostate cancer, the results of the phase trial are not yet available, but the number of reports showing efficacy by retrospective analysis is increasing. Progressive site-directed therapy has been shown to delay the next intervention and prolong progression-free survival, but its impact on subsequent treatment efficacy and contribution to overall survival has not been reported. The purpose of this retrospective study is to evaluate the impact of progressive site-directed therapy for oligometastatic castration-resistant prostate cancer on the subsequent treatment outcomes. We found that progressive site-directed therapy was associated with better response to subsequent androgen receptor axis-targeted drugs and better overall survival. Progressive site-directed therapy for oligometastatic castration-resistant prostate cancer may improve subsequent oncological outcomes. Abstract The purpose of this study was to evaluate the impact of progressive site-directed therapy (PSDT) for oligometastatic castration-resistant prostate cancer (OM-CRPC) on the efficacy of subsequent androgen receptor axis-targeted (ARAT) drugs, and to demonstrate the possibility of prolonging overall survival (OS). We performed a retrospective analysis of 15 OM-CRPC patients who underwent PSDT and subsequently received first-line ARAT drugs (PSDT group) and 13 OM-CRPC patients who were treated with first-line ARAT drugs without PSDT (non-PSDT group). PSDT was performed with the intention of treating all progressing sites detected by whole-body diffusion-weighted MRI with radiotherapy. Thirteen patients (86.7%) treated with PSDT had a decrease in PSA levels, which was at least 50% in 10 (66.7%) patients. The median PSA progression-free survival (PFS) for PSDT was 7.4 months. The median PSA-PFS for ARAT was 27.2 months in patients in the PSDT group and 11.7 months in the non-PSDT group, with a significant difference between the two groups (hazard ratio [HR], 0.28; p = 0.010). The median OS was not reached in the PSDT group and was significantly longer than 44.5 months in the non-PSDT group (HR, 0.11; p = 0.014). In OM-CRPC, PSDT may improve the efficacy of subsequent ARAT and OS.
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Donini M, Buti S, Massari F, Mollica V, Rizzo A, Montironi R, Bersanelli M, Santoni M. Management of oligometastatic and oligoprogressive renal cell carcinoma: state of the art and future directions. Expert Rev Anticancer Ther 2020; 20:491-501. [PMID: 32479120 DOI: 10.1080/14737140.2020.1770601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The aim of this paper was to perform a narrative review of the literature on the available approaches in the treatment of two emerging subpopulations of metastatic renal cell carcinoma (mRCC) patients: the oligometastatic disease (less than 5 metastasis) and the oligoprogressive disease, defined as worsening in maximum 3-5 sites while all other tumor sites are controlled by systemic therapy. AREAS COVERED We explore all possible approaches in these settings of patients: the role of local therapies, considering both surgical metastasectomy and/or ablative techniques, the efficacy of systemic therapies and the rationale behind active surveillance. We also discuss ongoing clinical trials in these settings. EXPERT OPINION Two different strategies are emerging as the most promising for the approach to the oligometastatic/oligoprogressive mRCC patient: (1) the use of immunocheckpoint inhibitors following metastasectomy; (2) the use of stereotactic radiotherapy alone or combined with immunotherapy for oligometastatic disease. The lack of validated biomarkers of response in these mRCC patient subpopulations is opening the way to the employment of novel technologies. Among them, the use of artificial intelligence seems to be the candidate to contribute to precision oncology in patients with mRCC.
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Affiliation(s)
- Maddalena Donini
- Division of Oncology, Medical Department, Azienda Socio Sanitaria Territoriale (ASST) of Cremona , Cremona, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma , Parma, Italy
| | | | - Veronica Mollica
- Division of Oncology, S. Orsola-Malpighi Hospital , Bologna, Italy
| | - Alessandro Rizzo
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital , Bologna, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals , Ancona, Italy
| | | | - Matteo Santoni
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals , Ancona, Italy.,Oncology Unit, Macerata Hospital , Macerata, Italy
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Ihnát P, Skácelíková E, Vávra P, Jonszta T, Ihnát Rudinská L, Tomášková H. Novel strategy in the treatment of liver metastases - Hepatic resection combined with stereotactic body radiotherapy. Asian J Surg 2020; 43:902-906. [PMID: 31911035 DOI: 10.1016/j.asjsur.2019.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To evaluate the safety, feasibility and outcomes of patients treated for colorectal liver metastases (CLM) with an innovative combined approach - hepatic resection and Stereotactic body radiotherapy (SBRT) using CyberKnife® system. METHODS This was a retrospective cohort study conducted in a single institution. Patients with CLM and no evidence of extrahepatic disease were included during a 6-year study period. RESULTS In total, 19 patients with 63 liver lesions underwent liver resection combined with SBRT of unresectable lesions. Major hepatectomy was performed in 42.1% patients; postoperative complications were noted in 31.6% patients. 27 unresectable lesions were treated by SBRT with a total dose of 50-60 Gy in five fractions. The median follow-up of study patients was 29.7 ± 20.58 months. Local control of CLM at 1 and 2 years was achieved in 89.5% of patients. Out-of-field hepatic recurrence was diagnosed in 63.1% patients. The 1-year disease-free survival (DFS) was 52.6%; 2-year DFS was 31.6%. The overall actuarial survival rates at 1 and 2 years were 88.2% and 50.4%. CONCLUSION Liver resection combined with SBRT presents a promising therapeutic option for patients with CLM which traditionally are unresectable. The additional use of SBRT allows for the effective clearance of the disease for thoroughly selected patients.
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Affiliation(s)
- Peter Ihnát
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic; Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic.
| | - Eva Skácelíková
- Department of Oncology, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Petr Vávra
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic; Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
| | - Tomáš Jonszta
- Department of Radiology, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Lucia Ihnát Rudinská
- Department of Forensic Medicine, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Hana Tomášková
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
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Stelcer E, Konkol M, Głȩboka A, Suchorska WM. Liquid Biopsy in Oligometastatic Prostate Cancer-A Biologist's Point of View. Front Oncol 2019; 9:775. [PMID: 31475117 PMCID: PMC6702517 DOI: 10.3389/fonc.2019.00775] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/31/2019] [Indexed: 12/13/2022] Open
Abstract
Prostate cancer (PCa) is the main cause of cancer-related mortality in males and the diagnosis, treatment, and care of these patients places a great burden on healthcare systems globally. Clinically, PCa is highly heterogeneous, ranging from indolent tumors to highly aggressive disease. In many cases treatment-generally either radiotherapy (RT) or surgery-can be curative. Several key genetic and demographic factors such as age, family history, genetic susceptibility, and race are associated with a high incidence of PCa. While our understanding of PCa, which is mainly based on the tools of molecular biology-has improved dramatically in recent years, efforts to better understand this complex disease have led to the identification of a new type of PCa-oligometastatic PCa. Oligometastatic disease should be considered an individual, heterogeneous entity with distinct metastatic phenotypes and, consequently, wide prognostic variability. In general, patients with oligometastatic disease typically present less biologically aggressive tumors whose metastatic potential is more limited and which are slow-growing. These patients are good candidates for more aggressive treatment approaches. The main aim of the presented review was to evaluate the utility of liquid biopsy for diagnostic purposes in PCa and for use in monitoring disease progression and treatment response, particularly in patients with oligometastatic PCa. Liquid biopsies offer a rapid, non-invasive approach whose use t is expected to play an important role in routine clinical practice to benefit patients. However, more research is needed to resolve the many existing discrepancies with regard to the definition and isolation method for specific biomarkers, as well as the need to determine the most appropriate markers. Consequently, the current priority in this field is to standardize liquid biopsy-based techniques. This review will help to improve understanding of the biology of PCa, particularly the recently defined condition known as "oligometastatic PCa". The presented review of the body of evidence suggests that additional research in molecular biology may help to establish novel treatments for oligometastatic PCa. In the near future, the treatment of PCa will require an interdisciplinary approach involving active cooperation among clinicians, physicians, and biologists.
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Affiliation(s)
- Ewelina Stelcer
- Radiobiology Laboratory, Greater Poland Cancer Centre, Poznan, Poland
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
- Department of Histology and Embryology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Konkol
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
- Radiation Oncology Department, Greater Poland Cancer Centre, Poznan, Poland
| | | | - Wiktoria Maria Suchorska
- Radiobiology Laboratory, Greater Poland Cancer Centre, Poznan, Poland
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
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Palacios-Eito A, Béjar-Luque A, Rodríguez-Liñán M, García-Cabezas S. Oligometastases in prostate cancer: Ablative treatment. World J Clin Oncol 2019; 10:38-51. [PMID: 30815370 PMCID: PMC6390116 DOI: 10.5306/wjco.v10.i2.38] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/30/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
Technological advances in radiotherapy have led to the introduction of techniques such as stereotactic body radiation therapy (SBRT), allowing the administration of ablative doses. The hypothesis that oligometastatic disease may be cured through local eradication therapies has led to the increasing use of SBRT in patients with this type of disease. At the same time, scientific advances are being made to allow the confirmation of clinically suspected oligometastatic status at molecular level. There is growing interest in identifying patients with oligometastatic prostate cancer (PCa) who may benefit from curative intent metastasis-directed therapy, including SBRT. The aim is to complement, replace or delay the introduction of hormone therapy or other systemic therapies. The present review aims to compile the evidence from the main ongoing studies and results on SBRT in relation to oligometastatic PCa; examine aspects where gaps in knowledge or a lack of consensus persist (e.g., optimum schemes, response assessment, identification and diagnosis of oligometastatic patients); and document the lack of first-level evidence supporting the use of such techniques.
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Affiliation(s)
- Amalia Palacios-Eito
- Department of Radiation Oncology, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Amelia Béjar-Luque
- Department of Radiation Oncology, Reina Sofia University Hospital, Cordoba 14004, Spain
| | | | - Sonia García-Cabezas
- Department of Radiation Oncology, Reina Sofia University Hospital, Cordoba 14004, Spain
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Lee YH, Kang KM, Choi H, Ha IB, Jeong H, Song JH, Jang I, Kim SH, Lee JW, Rhee DY, Jeong BK. Comparison of stereotactic body radiotherapy versus metastasectomy outcomes in patients with pulmonary metastases. Thorac Cancer 2018; 9:1671-1679. [PMID: 30298701 PMCID: PMC6275814 DOI: 10.1111/1759-7714.12880] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND We compared the treatment outcomes of stereotactic body radiotherapy (SBRT) and metastasectomy in patients with pulmonary metastases. METHODS Twenty-one patients received SBRT (total radiation doses 60 Gy in 3 fractions or 48 Gy in 4 fractions) and 30 underwent metastasectomy, most (93.3%) with wedge resection. The patients were followed for a median of 13.7 months. The tumor size in the SBRT group was larger than in the metastasectomy group (median 2.5 vs. 1.25 cm; P = 0.015). Patients with synchronous metastases were more likely to be treated with SBRT than with metastasectomy (P = 0.006). RESULTS There was no significant difference in the local control rates of the treatment groups (P = 0.163). Progression-free survival (PFS) was longer in the metastasectomy than in the SBRT group (P = 0.02), with one and two-year PFS rates of 51.1% and 46% versus 23.8% and 11.9%, respectively. The one and two-year overall survival (OS) rates were 95% and 81.8% in the metastasectomy group and 79.5% and 68.2%, in the SBRT group, respectively. In multivariate analysis, synchronous metastasis was related to poor PFS, and tumor size was the most significant factor affecting OS. There were no significant differences in PFS and OS between treatment groups after dividing patients according to the presence or absence of synchronous metastases. CONCLUSIONS SBRT is considered a suitable local modality against pulmonary metastases; however, patients with synchronous metastases are only likely to obtain a small benefit from local treatment with either SBRT or surgery.
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Affiliation(s)
- Yun Hee Lee
- Department of Radiation OncologyGyeongsang National University School of Medicine and Gyeongsang National University HospitalJinjuSouth Korea
- Institute of Health SciencesGyeongsang National UniversityJinjuSouth Korea
| | - Ki Mun Kang
- Institute of Health SciencesGyeongsang National UniversityJinjuSouth Korea
- Department of Radiation OncologyGyeongsang National University School of Medicine and Gyeongsang National University Changwon HospitalChangwonSouth Korea
| | - Hoon‐Sik Choi
- Department of Radiation OncologyGyeongsang National University School of Medicine and Gyeongsang National University Changwon HospitalChangwonSouth Korea
| | - In Bong Ha
- Department of Radiation OncologyGyeongsang National University School of Medicine and Gyeongsang National University HospitalJinjuSouth Korea
| | - Hojin Jeong
- Department of Radiation OncologyGyeongsang National University School of Medicine and Gyeongsang National University HospitalJinjuSouth Korea
- Institute of Health SciencesGyeongsang National UniversityJinjuSouth Korea
| | - Jin Ho Song
- Institute of Health SciencesGyeongsang National UniversityJinjuSouth Korea
- Department of Radiation OncologyGyeongsang National University School of Medicine and Gyeongsang National University Changwon HospitalChangwonSouth Korea
| | - In‐Seok Jang
- Department of Thoracic and Cardiovascular SurgeryGyeongsang National University School of Medicine and Gyeongsang National University HospitalJinjuSouth Korea
| | - Sung Hwan Kim
- Department of Thoracic and Cardiovascular SurgeryGyeongsang National University School of Medicine and Gyeongsang National University Changwon HospitalChangwonSouth Korea
| | - Jeong Won Lee
- Department of Radiation OncologyCatholic University of Daegu School of MedicineDaeguSouth Korea
| | - Dong Yoon Rhee
- Department of Emergency MedicineHanmaeum General HospitalJejuSouth Korea
| | - Bae Kwon Jeong
- Department of Radiation OncologyGyeongsang National University School of Medicine and Gyeongsang National University HospitalJinjuSouth Korea
- Institute of Health SciencesGyeongsang National UniversityJinjuSouth Korea
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Ihnát P, Skácelíková E, Tesař M, Penka I. Stereotactic body radiotherapy using the CyberKnife ® system in the treatment of patients with liver metastases: state of the art. Onco Targets Ther 2018; 11:4685-4691. [PMID: 30127616 PMCID: PMC6091471 DOI: 10.2147/ott.s165878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The management of patients with liver metastases presents a challenging problem in clinical oncology. Patients with limited involvement of the liver may be suitable for surgical resection or local ablative techniques. Stereotactic body radiotherapy (SBRT) presents an emerging new technology that has shown high efficacy in ablating tumors at various disease sites. Methods A comprehensive literature search was performed to identify articles in regard to the SBRT in the treatment of patients with liver metastases. Results SBRT allows for the delivery of high-dose radiation in few fractions to the tumor with extreme accuracy, while minimizing the damage to normal surrounding tissue. The CyberKnife® system is an image-guided robotic system that delivers SBRT, tracks tumors during respiration, and automatically adjusts treatment for any patient movement. The most frequently used indications for CyberKnife® therapy are ≤5 liver metastases with maximum tumor sizes of 6 cm, no extrahepatic disease, good performance status, and adequate hepatic functions. Local control rates range from 70%-100% at 1 year and from 60%-90% at 2 years. Severe toxicity related to SBRT is uncommon - grade three side effects occur in less than 5% of cases. Despite excellent local control rates, out-of-field metastatic progression (out-of-field hepatic metastases and extrahepatic metastases) develops in a substantial proportion of patients after SBRT. Therefore, it seems essential to improve the selection of patients with liver metastases for SBRT. Conclusion The CyberKnife® system presents an effective minimally invasive treatment modality for patients with hepatic oligometastases who are not suitable candidates for radical liver resection. The available data suggest that liver metastases can be treated by CyberKnife therapy with very low toxicity and excellent local control rates.
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Affiliation(s)
- Peter Ihnát
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic, .,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic,
| | - Eva Skácelíková
- Department of Oncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Milan Tesař
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic, .,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic,
| | - Igor Penka
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic, .,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic,
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Conti A, D’Elia C, Cheng M, Santoni M, Piva F, Brunelli M, Lopez-Beltran A, Giulietti M, Scarpelli M, Pycha A, Galosi AB, Artibani W, Cheng L, Montironi R, Battelli N, Lusuardi L. Oligometastases in Genitourinary Tumors: Recent Insights and Future Molecular Diagnostic Approach. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.eursup.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Guezennec C, Keromnes N, Robin P, Abgral R, Bourhis D, Querellou S, de Laroche R, Le Duc-Pennec A, Salaün PY, Le Roux PY. Incremental diagnostic utility of systematic double-bed SPECT/CT for bone scintigraphy in initial staging of cancer patients. Cancer Imaging 2017; 17:16. [PMID: 28592305 PMCID: PMC5463363 DOI: 10.1186/s40644-017-0118-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/23/2017] [Indexed: 02/01/2023] Open
Abstract
Background SPECT/CT has been shown to increase the diagnostic performance of bone scintigraphy for staging of malignancies. A systematic double-bed SPECT/CT of the trunk may allow further improvement. However, this would be balanced by higher dosimetry and longer acquisition time. The objective was to assess the incremental diagnostic utility of a systematic double-bed SPECT/CT acquisition for bone scintigraphy in initial staging of cancer patients, especially compared with the usual approach consisting in a whole body planar scan (WBS) plus one single-bed targeted SPECT/CT. Methods One hundred two consecutive patients referred for bone scintigraphy for initial staging of malignancy were analyzed. All patients underwent a double-bed SPECT/CT acquisition of the trunk. Images were interpreted by two nuclear medicine physicians in a 3-step procedure. Firstly, only WBS planar images were used; secondly, one additional single-bed SPECT/CT chosen based on planar images was used; finally, WBS planar and double-bed SPECT/CT images were interpreted. Lesions were classified as benign, equivocal or suspicious for metastasis. A per-lesion, per-anatomical region and per-patient analysis was performed. Results In a per-lesion analysis, the number of equivocal and suspicious lesions was 91 and 241 using WBS planar images, 17 and 259 using a single-bed SPECT/CT acquisition and 11 and 269 using double-bed SPECT/CT images, respectively. In a per-patient analysis, the diagnostic conclusion was negative, equivocal or suspicious for malignancy in 35, 53 and 14 patients using WB planar images, 77, 6 and 19 patients using an additional single-bed SPECT/CT and 76, 7 and 19 using double-bed SPECT/CT images, respectively. Seventeen lesions unseen on WBS images were interpreted as suspicious (n = 12) or equivocal (n = 5) on double-bed SPECT/CT images. Six lesions unseen on “WBS + targeted single-bed SPECT/CT” were interpreted as suspicious on double-bed SPECT/CT, with no shift in the metastatic status of patients. Conclusion A systematic double-bed SPECT/CT acquisition has a limited incremental diagnostic value over an oriented single-bed SPECT/CT in terms of specificity and conclusiveness of bone scintigraphy in the initial staging of cancer patients. However, it slightly improved the sensitivity of the test by detecting unseen lesions on WBS, which may be of value for initial staging of cancer.
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Affiliation(s)
- Catherine Guezennec
- Service de Médecine Nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Brest, France.
| | - Nathalie Keromnes
- Service de Médecine Nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Brest, France
| | - Philippe Robin
- Service de Médecine Nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Brest, France
| | - Ronan Abgral
- Service de Médecine Nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Brest, France
| | - David Bourhis
- Service de Médecine Nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Brest, France
| | - Solène Querellou
- Service de Médecine Nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Brest, France
| | - Romain de Laroche
- Service de Médecine Nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Brest, France
| | | | - Pierre-Yves Salaün
- Service de Médecine Nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Brest, France
| | - Pierre-Yves Le Roux
- Service de Médecine Nucléaire, EA3878 (GETBO) IFR 148, CHRU de Brest, Brest, France
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Rancoule C, Pacaut-Vassal C, Vallard A, Mery B, Trone JC, El Meddeb Hamrouni A, Magné N. [Reappraisal role of locoregional radiation therapy in metastatic cancers]. Bull Cancer 2016; 104:86-91. [PMID: 27955816 DOI: 10.1016/j.bulcan.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022]
Abstract
Recent innovations in oncology area helped to improve the prognosis of certain cancers including metastatic ones with a decrease in mortality. Recommendations describe the treatment of metastatic cancer as systemic therapy or complementary care and the role of locoregional treatment in the treatment plan only occurs in a palliative context. Currently, in the clinical practice, out of "the evidence based medicine", an early locoregional therapy (surgery or radiation therapy) can be proposed in several cases of metastatic cancers. The aim of the present review is to describe the role of the primary tumor radiation therapy in metastatic disease. In metastatic breast, prostate, cervix, rectal or nasopharyngeal cancers, locoregional treatment including radiation therapy can, in some cases, be discussed and decided in MDT. Ongoing clinical trials in these locations should soon precise the benefit of this locoregional treatment. It will also be important to define the specific criteria in order to select patients who could benefit from this treatment.
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Affiliation(s)
- Chloé Rancoule
- Institut de cancérologie Lucien-Neuwirth, département universitaire de la recherche et de l'enseignement, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France; Laboratoire de radiobiologie cellulaire et moléculaire de Lyon Sud - CNRS UMR 5822, 165, chemin du Grand-Revoyet, BP 12, 69921 Oullins cedex, France
| | - Cécile Pacaut-Vassal
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France
| | - Alexis Vallard
- Institut de cancérologie Lucien-Neuwirth, département universitaire de la recherche et de l'enseignement, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France
| | - Benoite Mery
- Laboratoire de radiobiologie cellulaire et moléculaire de Lyon Sud - CNRS UMR 5822, 165, chemin du Grand-Revoyet, BP 12, 69921 Oullins cedex, France; Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France
| | - Jane-Chloé Trone
- Institut de cancérologie Lucien-Neuwirth, département universitaire de la recherche et de l'enseignement, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France
| | - Anis El Meddeb Hamrouni
- Institut de cancérologie Lucien-Neuwirth, département universitaire de la recherche et de l'enseignement, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France
| | - Nicolas Magné
- Institut de cancérologie Lucien-Neuwirth, département universitaire de la recherche et de l'enseignement, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France; Laboratoire de radiobiologie cellulaire et moléculaire de Lyon Sud - CNRS UMR 5822, 165, chemin du Grand-Revoyet, BP 12, 69921 Oullins cedex, France.
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